New York state's paid family leave improved postpartum health care among women with hypertensive disorders in pregnancy

Abstract

Introduction: Hypertensive disorders in pregnancy, including chronic and pregnancy-induced hypertension, pose significant risks to maternal health. This study evaluated the association of New York State (NYS)'s Paid Family Leave (PFL) law, implemented in 2018, with postpartum healthcare utilization among women with hypertensive disorders in pregnancy.

Methods: Using commercial claims data (2017-2022) for 312 470 employed women aged 15-45 years with live births, we assessed postpartum outpatient visits, hospital admissions, and medication adherence.

Results: The PFL law was associated with a 3.7%-point increase in outpatient visits within 7 days postpartum for women with chronic hypertension (from 25.9% to 29.6% in NYS, P < 0.001) and an 8.6%-point increase for women with pregnancy-induced hypertension (from 26.3% to 35.0%) in NYS, P < 0.001). The PFL law was associated with a 1.5%-point reduction in inpatient admissions for women with chronic hypertension (from 3.6% to 2.1% in NYS, P < 0.001), and a 7.1%-point improvement in antihypertensive medication adherence for women with chronic hypertension (from 26.6% to 33.8% in NYS, P < 0.001).

Conclusion: Study findings suggest that PFL laws may enhance postpartum hypertension management, providing useful insights for policymakers aiming to improve maternal health outcomes through workplace policies.

Keywords: New York State; hypertensive disorders in pregnancy; maternal mortality and morbidity; paid family leave; postpartum health care.

Figure 1.

States that implemented or will implement the Paid Family Leave Laws, 2004-2026. Source: Authors' analysis of data from the governmental websites, including https://edd.ca.gov/en/disability/paid-family-leave/, https://famli.colorado.gov/, https://www.ctpaidleave.org/, https://labor.delaware.gov/delaware-paid-leave-is-coming/, https://www.mass.gov/info-details/paid-family-and-medical-leave-pfml-overview-and-benefits, https://www.dllr.state.md.us/famli/, https://www.nj.gov/labor/myleavebenefits/worker/fli/, https://paidfamilyleave.ny.gov/, https://paidleave.oregon.gov/, http://ripaidleave.net/, https://paidleave.wa.gov/, https://dcpaidfamilyleave.dc.gov/. Year of enactment and year of implementation as well as the funding sources were gathered. States and year of implementation of the paid maternity law were presented in the figure.

Figure 2.

Association between Paid Family Leave Laws and health services utilization within 7 and 42 days postpartum, 2017-2022. Source: Authors' analysis of data from the MarketScan® Commercial Claims and Encounters Database, 2017-2022. We used logit models to estimate the association between paid maternal leave laws and the likelihood of having at least one outpatient visit within 7 and 42 days after delivery and having at least one emergency department (ED) visit or inpatient admission within 42 days after hospital delivery. The results were stratified into three groups based on hypertension status: women without hypertension, women with chronic hypertension, and women with pregnancy-induced hypertension. All models were adjusted for age group, urbanicity of residence, part-time employment status, comorbidities, state-year covariates, and year and state fixed effects. Standard errors were clustered by state of residence. We report average marginal effects with 95% CIs as follows, representing percentage point changes.

Figure 3.

The association of Paid Family Leave Laws with medication adherence and number of antihypertensive prescriptions filled among those prescribed antihypertensives, 2017-2022. Source: Authors' analysis of data from the MarketScan® Commercial Claims and Encounters Database, 2016-2022. We used a logit model to analyze the association between paid maternal leave laws and the likelihood of adhering to antihypertensive medications (medication possession ratio ≥ 80%) at the first one, three and six months postpartum. To assess the number of antihypertensive prescriptions filled at the first 1, 3 and 6 months postpartum, we used a negative binomial regression model. Results were stratified into two groups: those with chronic hypertension, and those with pregnancy-induced hypertension. All models were adjusted for age group, urbanicity of residence, part-time employment status, comorbidities, state-year covariates, and fixed effects for year and state. Standard errors were clustered by state of residence. We report average marginal effects with 95% CIs as follows, with estimates representing percentage point changes.